Provider Demographics
NPI:1801180823
Name:BEACHAM, HALLIE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:HALLIE
Middle Name:ANN
Last Name:BEACHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22200 PUCCIONI RD
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-9737
Mailing Address - Country:US
Mailing Address - Phone:707-431-2827
Mailing Address - Fax:707-431-7342
Practice Address - Street 1:22200 PUCCIONI RD
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-9737
Practice Address - Country:US
Practice Address - Phone:707-431-2827
Practice Address - Fax:707-431-7342
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24621174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist